What's going on with King County's medicine return program?

When the state legislature failed to pass bills that would establish a statewide medicine return program two years in a row, Prevention WINS joined other substance abuse prevention, healthcare, and environmental organizations to advocate for a program in King County.  Medicine return programs are part of a multi-pronged strategy for preventing prescription drug abuse among teenagers by reducing access to the drugs in homes.

In 2013, the King County Board of Health adopted a secure medicine return program despite threats by drug manufacturers, who would be responsible for the program, of a lawsuit.  Drug companies filed a lawsuit against King County a few months after the policy was adopted.  They had already filed a lawsuit against Alameda County in California which adopted a similar policy in 2012. The drug manufacturers claim that the policy violates the United States Constitution. 

In 2014, a federal appeals court disagreed with the drug manufacturers who are now appealing to the Supreme Court.  The lawsuit against King County is on hold until a final court decision is made in the Alameda County case.  In the meantime, King County is moving forward with the implementation process which will lead to medicine return drop boxes in all pharmacies in the county. 

Teen drug abuse is a community problem that requires prevention activities conducted by multiple organizations.  Like schools implementing prevention programs, parents monitoring the medications in their homes, police hosting regular medicine take-back days, and physicians using the Prescription Monitoring Program, drug manufacturers can play a key role by running take-back programs. 

Why preventing prescription drug abuse is important

Over the past week, a few posts focused on what coalitions can do to prevent teen medicine abuse.  Since I realize I may have put the cart before the horse, today's post will explain why preventing teen prescription painkiller abuse is important.  

Prescription medicine abuse is the intentional use of a medication without a prescription; in a way other than as prescribed; or for the experience or feeling it causes.  According to the National Institutes on Drug Abuse, the medications most commonly abused are pain relievers/opioids.  

Prescription opioids act on the brain like heroin does and can be highly addictive.  As a 2013 report on the problem in WA states, "For some, abuse of prescription-type opiates . . . leads to heroin use so preventing inappropriate use of prescription opiates is important." 

Abuse of opioids, alone or with other drugs including alcohol, can depress breathing and lead to death. In King County, the Poison Center reports that oxycodone and hydrocodone (both opiods) are the most common drugs mentioned in prescription drug-related overdose reports.  Prescription opiates and heroin are the top two causes of drug-related deaths in King County.  Since 2009, as prescription opiate-related deaths decreased heroin-related deaths increased.  

Source: Alcohol and Drug Abuse Institute's 2013 report on King County drug trends.  

Different communities will have different prevention activities to address teen medicine abuse

Last week, two posts told the stories of community coalitions that conducted successful campaigns to prevent teen medicine abuse.  Well, I have one more.

I share this last one as an example of how prevention campaigns are different depending on the local community.  The coalition profiled in the video below implemented prevention activities that are different from the coalitions profiled in the other videos.  The stories highlight that every community is going to have different responses to teen medicine abuse, and other teen drug abuse problems, depending on what their local data tell them, who is involved in the coalition, and the capacity of coalition members to do something.

Everyone has a role to play in preventing teen medicine abuse

On Wednesday, I blogged about the importance of a community response to teen medicine abuse.  Below is another example of how community members can incorporate prevention activities into their work as part of a multi-pronged coalition strategy.  The video highlights how prevention activities can be sustained when community partners take ownership of them.

Preventing teen medicine abuse at the local level

The abuse of prescription drugs among NE Seattle teenagers increased steadily over the past few years.

Source: Washington State Healthy Youth Survey

During the 2012-13 school year, Prevention WINS members advocated for the King County Board of Health to adopt a countywide medicine return program.  It was adopted in June 2013 but is not yet up and running because pharmaceutical companies are suing to stop it.  The program will be one way to reduce the amount of unused prescription medicines in homes and therefore reduce youth access to them.

Prevention WINS members also promote the twice-yearly national Prescription Drug Take-Back Day.  The next one is Saturday, September 27 from 10:00 a.m. to 2:00 p.m..  All Seattle Police Department precincts will accept unused medications.  Materials for promoting the day are available on the King County Take Back Your Meds website.

Since substance abuse prevention activities are most effective when multiple community sectors address specific local problems, coalitions can be especially important for reducing teen medicine abuse.  The following video tells the story of one community coalition that is using a variety of approaches, guided by local data, to prevent medicine abuse.

Prevention WINS will plan for additional prevention activities during the September 16 general meeting. Please contact coalition staff for more information.  

Take back your meds to police precincts April 26

On April 26 from 10 a.m. to 2 p.m. Seattle Police Department precincts and the Drug Enforcement Administration (DEA) will give the public its eighth opportunity in three years to prevent pill abuse by ridding their homes of potentially dangerous expired, unused, and unwanted prescription drugs.  Bring your pills for disposal to a SPD precinct.  (The DEA cannot accept liquids or needles or sharps, only pills or patches.)  The service is free and anonymous, no questions asked.

Community partners are called to publicize this event.  To help with publicity, a toolkit that includes flyers and web buttons is available online.  

Last October, Americans turned in 324 tons (over 647,000 pounds) of prescription drugs at over 4,114 sites operated by the DEA and its thousands of state and local law enforcement partners.  

This initiative addresses a vital public safety and public health issue.  Medicines that languish in home cabinets are highly susceptible to diversion, misuse, and abuse.  During the March Prevention WINS coalition meeting, members identified home medicine cabinets as the primary way NE Seattle students who abuse these drugs get them.   In addition, Americans are now advised that their usual methods for disposing of unused medicines—flushing them down the toilet or throwing them in the trash—both pose potential safety and health hazards.

Rates of prescription drug abuse in the U.S. are alarmingly high and prescription drug abuse rates have steadily increased among NE Seattle students since 2006. 

While the King County Board of Health approved a secure medicine return program last year, the program is not up and running, yet.

Macklemore talks about addiction

In Seattle, Macklemore needs no introduction.  In this video, he talks about his struggle with addiction to raise awareness among young people about the dangers of prescription drug abuse.

Get More: 

www.mtvu.com

Macklemore starts the video with a story about how he started drinking when he was 14.  On average, NE Seattle high school students who drink started between ages 13 and 14.  As his story goes on, it is evident that he, like most teenagers who use drugs, used a variety of drugs.

In the end, he talks about his addiction to prescription drugs.  His message is especially relevant in NE Seattle where prescription drug abuse has steadily increased among teens since 2008.

Parents underestimate teen abuse of ADHD drugs

Taking ADHD medication such as Ritalin and Adderall seems to be increasingly popular amongst young people wanting to improve their academic performance.

To examine parents’ awareness about this emerging issue, the C.S. Mott Children’s Hospital National Poll on Children’s Health asked anational sample of parents about their teens’ use of “study drugs” and their level of concern about the misuse of “study drugs” in their communities.

Among parents of 13- to 17-year-olds who have not been prescribed such medicines, 1 in 100 say their teens have used a “study drug” to stay awake to study for an exam or to do homework.  At the same time, 1 in 8 high school seniors report using “study drugs”.   

Learn more:

King County Board of Health approves medicine return regulation

Great news from the King County Board of Health:

Yesterday, the King County Board of Health took a significant step towards reducing preventable deaths from drug overdoses by passing a Rule & Regulation to create a drug take-back system for King County residents. The program promotes the safe disposal of unused prescription and over-the-counter medicines, and will be funded and operated by the drug manufacturers who produce the medications.

Under the new program residents may dispose of unwanted medicines at pharmacies and other secure locations across the county for no charge. The new law will create only the second such system in the country. 

"Today's vote makes us the second jurisdiction in the nation to provide a safe and convenient way for residents to get rid of their unneeded medicines. I am proud of my fellow board members for passing this historic Rule & Regulation," said Board of Health Chair Joe McDermott. "The Board took strong action today to close a gap in the comprehensive response to misuse and abuse of medicines."

Board members recognized that more people die from overdoses due to prescription medicines than from heroin and cocaine combined and that most abusers of medicines get the pills from a friend or relative's medicine cabinet. In fact, 32% of child poisoning deaths in Washington were caused by someone else's prescription medication, and 26% were caused by over-the-counter medicines.

"The more effective solution to the drug abuse crisis is prevention," said Boardmember Dr. Bud Nicola. "Making it easy for residents to use a take-back system means fewer drugs in medicine cabinets, leading to fewer overdoses and poisonings."

“Requiring the drug manufacturers to pay for the disposal of their products is good product stewardship," said Boardmember and Seattle City Councilmember Richard Conlin. "A convenient take back system will keep drugs out of the hands of children and teenagers."

"This is a common sense solution to a problem we've known about for a long time," said Boardmember David Baker, Mayor of Kenmore. "This program is part of a comprehensive approach to address our community's drug overdose and poisoning epidemic."

Video: Why King County needs a medicine return program

Earlier today, the following video was posted to King County's YouTube page.  Please share it!

Seattle City Council to vote on resolution supporting medicine return program

On Monday, the Seattle City Council will vote on a resolution "Supporting creation of a secure, convenient medicine return program in King County to reduce the public safety and environmental impacts of unwanted medicines." 

The resolution starts by stating:

WHEREAS, drug overdose deaths, abuse of prescription pain killers, and abuse of medicines by young people is a growing problem, and more people die of prescription medicines than all illegal drugs combined; and

WHEREAS, medicines used in the home are the leading cause of poisonings reported to the Washington Poison Center, and preventable poisonings from medicines have been rising rapidly, especially among children and seniors; and

WHEREAS, unwanted medicines left in the home contribute to opportunities for drug abuse, drug theft, and accidental poisonings; and . . .

The resolution was introduced by Councilmember Richard Conlin who is also a member of the King County Board of Health.  If you've been following this blog, you know that the Board will vote next week on policy that would establish a medicine return program.

Please consider thanking Councilmember Conlin for his support of policy that can help reduce youth medicine abuse. 

Prescription painkiller abuse linked to rise in heroin use in Washington

According to a report recently released by the University of Washington Alcohol and Drug Abuse Institute (ADAI), Washington 10th grade students who abuse prescription painkillers are more likely to have tried heroin than students who had not abused painkillers.  The chart below illustrates the connection between prescription painkillers and heroin use among 10th grade students.

This is especially troubling in NE Seattle because over the past six years teenagers in our community have increasingly reported that they abuse prescription drugs.

The ADAI study also reports that heroin use has more than doubled over the past ten years in people under 30 in our state.  Along with that use comes an increase in substance abuse treatment admissions for heroin among young adults ages 18 to 29 years old. 

One way to prevent heroin use among young adults is to prevent prescription drug abuse among teenagers.  The Prevention WINS coalition educates parents about the dangers of prescription drug abuse and advises them to monitor and lock up their medications.  Families should also dispose of unused medicines.  The most environmentally-friendly and safe way to dispose of unused medicines is to take advantage of medicine return programs that, in NE Seattle, are offered at Group Health and at some Bartell drug stores.

Since medicine return programs are not available consistently throughout the county, the King County Board of Health is considering adopting a policy that would establish a permanent program funded and implemented by drug manufacturers.  The Board will vote on the proposed policy during their June 20 meeting.  Prevention WINS is a member of the King County Take Back Your Meds Coalition and supports the proposed policy.

Why is a medicine return program needed in King County?

First some background information about the problem of prescription drug abuse.

Hospitalizations continue to increase
According to the Washington State Department of Health, hospitalizations for prescription painkiller overdoses continue to rise in our state. 

CDC says the problem is epidemic
This is a national problem, as well.  According to the Office of National Drug Control Policy (ONDCP):

The Centers for Disease Control and Prevention has classified prescription drug abuse as an epidemic. While there has been a marked decrease in the use of some illegal drugs like cocaine, data from the National Survey on Drug Use and Health (NSDUH) show that nearly one-third of people aged 12 and over who used drugs for the first time in 2009 began by using a prescription drug non-medically.

Some individuals who misuse prescription drugs, particularly teens, believe these substances are safer than illicit drugs because they are prescribed by a healthcare professional and dispensed by a pharmacist. Addressing the prescription drug abuse epidemic is not only a top priority for public health, it will also help build stronger communities and allow those with substance abuse disorders to lead healthier, more productive lives.

ONDCP's Prescription Drug Abuse Prevention Plan
The national 2011 Prescription Drug Abuse Prevention Plan includes action in four major areas to reduce prescription drug abuse:

1. Education. A crucial first step in tackling the problem of prescription drug abuse is to educate parents, youth, and patients about the dangers of abusing prescription drugs, while requiring prescribers to receive education on the appropriate and safe use, and proper storage and disposal of prescription drugs.

2. Monitoring. Implement prescription drug monitoring programs (PDMPs) in every state to reduce “doctor shopping” and diversion, and enhance PDMPs to make sure they can share data across states and are used by healthcare providers.

3. Enforcement. Provide law enforcement with the tools necessary to eliminate improper prescribing practices and stop pill mills.

4. Proper Medication Disposal. Develop convenient and environmentally responsible prescription drug disposal programs to help decrease the supply of unused prescription drugs in the home.

Are these things going on locally?
In King County, the first three strategies are in place either through local community activities or the implementation of the prescription monitoring program in our state.

What’s missing?

An ongoing medication disposal program. But King County can change that. 

On May 16, the King County Board of Health is holding a public hearing about proposed policy to start a permanent medicine return program countywide.  See yesterday's post for more information. 

King County Board of Health to hold public hearing on proposed medicine return policy

Your voice is needed!

Public Hearing:
Establishing a King County Medicine Return Program

King County Board of Health Meeting
Thursday, May 16, 1:30 p.m.
King County Courthouse, 10th Floor
516 Third Avenue, Seattle

Background
In 2012, the King County Board of Health established a subcommittee to explore how it can support the safe disposal of unused and unwanted medications. With prescription drug abuse and accidental poisonings on the rise in King County, an ongoing, county-wide medicine return program funded by producers is part of a comprehensive prevention strategy.

What is being proposed?
The Board of Health subcommittee is proposing that the producers of medicines fund and implement a county-wide secure medicine return program at pharmacies and law enforcement agencies using a product stewardship model. A product stewardship model recognizes that everyone involved in the lifespan of medications has a responsibility to reduce its health and safety impacts. For producers, this includes planning and paying for the disposal of medicines at the end of their useful life.

What is this public hearing all about?
During the May 16, 2013 Board of Health meeting, individuals are encouraged to provide 2-minute testimony about the subcommittee’s proposal to establish a permanent medicine return program. The hearing will provide Board of Health members with information about why such a program is important for reducing youth prescription drug abuse and accidental poisonings.

How can I testify?
Show up at the Board of Health meeting on May 16 and sign in as a speaker. Individuals and organizations in favor of the proposed policy are coordinating so that we may take full advantage of the limited time each speaker has.

Can’t make the hearing?
Contact the Board of Health and tell them you support the establishment of a medicine return program. Comments should be submitted to the Board of Health, Attn: Maria Wood at maria.wood@kingcounty.gov.

Why is a take-back program needed?
Visit the King County Take Back Your Meds coalition webpage for information about the prescription drug abuse problem and the need for a comprehensive prevention strategy including a permanent medicine take back program.

Online TV show explains link between prescription painkillers and heroin

The push to reduce the supply of painkillers  is creating a new problem. Opiate addicts need their fix, so when they can’t easily get their pills, they’re often turning to heroin. During our next CADCA TV show, “Highway to Heroin,” airing February 28, experts will discuss how communities are dealing with two serious drug problems at the same time and how your community can prepare for an influx of heroin.

The show will also explore how the Community Awareness and Prevention Association coalition is working to prevent opiate use. Heroin use is now an epidemic in and around the areas of Cleveland, Ohio. Its use increased after painkiller users switched to heroine when the pain medications became harder to find.

Key concepts:
- Learn about the link between prescription painkillers and heroin

- Find out how to prepare your community for an increase in heroin use

- Hear what prevention strategies work best to educate about opiates

The show, which is hosted by CADCA’s Mary Elizabeth Elliott, will feature Marc J. Fishman, M.D., Addiction Psychiatrist, Faculty, Johns Hopkins University School of Medicine; Lisa Roberts, R.N., Portsmouth City Health Department, Portsmouth, Ohio; and Harold Rochon, Lieutenant, Detroit Police Department.

How to Watch:
All CADCA TV shows are free of charge and can be viewed via live webcast. Simply click on “View Webcast” on the webpage of the CADCA TV show you’re interested in watching.

ADHD drugs misused by some students to help them study

From New Day NW:

Seattle Seahawks cornerbacks Brandon Browner and Richard Sherman face four-game suspensions for reportedly testing positive for Adderall, in violation of the NFL's ban on performance enhancing drugs. The news sparked conversation about the popularity of the drug from professional sports to high schools. Adderall is commonly prescribed for people with Attention Deficit Hyperactivity Disorder (ADHD), to help them focus.  It's been misused and abused by everyone from students looking to intensely focus as they study for exams, to professional athletes looking for an extra "edge" on the field.

September 29: National medicine return day

 On September 29 from 10 a.m. to 2 p.m. the Seattle Police Department and the Drug Enforcement Administration (DEA) will give the public another opportunity to prevent pill abuse and theft by ridding their homes of potentially dangerous expired, unused, and unwanted prescription drugs.  Bring your medications for disposal to your local precinct.  The service is free and anonymous, no questions asked.

Last April, Americans turned in 552,161 pounds—276 tons—of prescription drugs at over 5,600 sites operated by the DEA and nearly 4,300 state and local law enforcement partners.  In its four previous Take Back events, DEA and its partners took in over 1.5 million pounds—nearly 775 tons—of pills. 

This initiative addresses a vital public safety and public health issue.  Medicines that languish in home cabinets are highly susceptible to diversion, misuse, and abuse. Rates of prescription drug abuse in the U.S. are alarmingly high, as are the number of accidental poisonings and overdoses due to these drugs.  Studies show that a majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet. In addition, Americans are now advised that their usual methods for disposing of unused medicines—flushing them down the toilet or throwing them in the trash—both pose potential safety and health hazards.

Four days after the first event, Congress passed the Secure and Responsible Drug Disposal Act of 2010, which amends the Controlled Substances Act to allow an “ultimate user” of controlled substance medications to dispose of them by delivering them to entities authorized by the Attorney General to accept them.  DEA is drafting regulations to implement the Act.  Until new regulations are in place, local law enforcement agencies like the Seattle Police Department and the DEA will continue to hold prescription drug take-back events every few months.

Locally, the King County Board of Health's Subcommittee on Secure Medicine Return is exploring how it can support safe disposal of unused medicines.  

Prescription drug abuse in the news

Over at Teenology 101, they discuss teen mental health, pain and prescription drug abuse.  They refer to a new study that shows that young people who take opiates like Oxycontin for chronic pain are more than twice as likely to become addicted to the drugs if they have a mental health condition

Sunday's New York Times included an article, Risky Rise of the Good-Grade Pill, about teenagers who abuse prescription medications meant to treat ADHD so that they may focus on studying to get good grades.  The Times' Room for Debate section features differing opinions about prescribing medications for ADHD and their link to drug abuse.

Over at the JoinTogether blog, a Congressman from Kentucky writes about his efforts to prevent prescription drug abuse.

The MSNBC website includes and article entitled, "Opiate addiction: How prescription painkillers pave the way to heroin."

The National Drug Control Strategy puts a focus on prevention prescription drug abuse.  In response to a prescription drug abuse problem designated as an epidemic by the Centers for Disease Control and Prevention, the White House is implementing of the Prescription Drug Abuse Prevention Plan.

Locally, the Take Back Your Meds campaign continues to advocate for a statewide medicine return program.

Take Back Your Meds Coalition receives public health award

Congratulations Take Back Your Meds Coalition for receiving a 2012 Health Champions Award from the Washington State Public Health Association!  The coalition received the award under the Alcohol/Tobacco/Other Drug Prevention category.  According to the WSPHA website:


Take Back your Meds, a coalition of 270 organizations from across Washington, supports medicine take back programs aimed at reducing access to unwanted medicines, risk of poisoning and environmental contamination. Coalition members include law enforcement and environmental groups, medical organizations and wastewater agencies, working family and natural resources organizations.  Over the last several years, the coalition has successfully worked to increase awareness of the problem of unwanted medications and improper disposal methods.  Coalition members have taken the initiative (and supported the cost) of operating temporary take back programs in 17 of Washington’s 39 counties, collecting over 160,000 pounds of medicines.  Additionally, they have also dedicated significant time and effort to pass legislation to create a secure, statewide medicine take-back program provided by pharmaceutical manufacturers. While legislation has not yet been passed, these efforts did garner extensive media coverage, with over 40 articles published in 2012 alone, reinforcing the importance of this issue.

CDC: drug overdoses may soon overtake car crashes as leading cause of fatal injury

From the Centers for Disease Control and Prevention (CDC):

Deaths from prescription painkillers have reached epidemic levels in the past decade. The number of overdose deaths is now greater than those of deaths from heroin and cocaine combined. A big part of the problem is nonmedical use of prescription painkillers—using drugs without a prescription, or using drugs just for the "high" they cause.